Cultural concepts of distress, psychiatric disorders, and social distance: Measuring mental health stigma in Guatemala.

Abstract

Stigma toward psychiatric disorders is documented worldwide. While the extent of stigma may vary within and between contexts, stigma toward psychiatric conditions is frequently driven by labeling, perceptions of violence, notions of causation, and behaviors associated with different conditions. However, as stigma attacks "what matters most," interpretations of mental health may depend on sociocultural values and structures which require attention to cultural concepts of distress (CCDs). Most ethnographic studies argue that CCDs are not as stigmatized as psychiatric disorders as they represent culturally recognized and acceptable mechanisms for individuals to express experiences of suffering, critique social structures and relations, and call for social support. Yet, few studies systematically analyze stigma toward CCDs, or compare it to stigma toward psychiatric disorders. In this article, we examine factors that influence stigma toward three psychiatric disorders (alcohol use disorder [AUD], major depression, and schizophrenia) and three CCDs (ataque de nervios, nervios, and susto) among a sample of women in a Highland Guatemalan town. Using a survey design, we evaluate the impact of different factors on preferences for social distance relating to standardized vignettes for each condition. Results suggest that there is greater stigma toward AUD and schizophrenia while ataque de nervios and nervios are less stigmatized compared to a "troubled person" baseline. Notions of labeling, causation, and violence influence the significance of these differences. This study emphasizes the need to understand how CCDs and psychiatric disorders are differentiated in public perception and how sociocultural values, norms, and structures shape expressions of stigma. Clinical Impact StatementIn this study, we test the hypothesis that cultural concepts of distress are less stigmatized in Latin America than psychiatric disorders. Using a series of standardized vignettes for different conditions, we measure the factors influencing preferences for social distance. We find that some CCDs, like ataque de nervios and nervios, are less stigmatized and that factors including labeling something a mental disorder, notions of causation, and perceptions of violence influence participants' willingness for social interaction. This study contributes to the understanding of how cultural values, norms, and structure shape expressions of mental health stigma.